Provider Demographics
NPI:1700833258
Name:GULLICK, EUGENIA LEE (PHD)
Entity Type:Individual
Prefix:DR
First Name:EUGENIA
Middle Name:LEE
Last Name:GULLICK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6201 FAIRVIEW RD
Mailing Address - Street 2:SUITE #200
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-3289
Mailing Address - Country:US
Mailing Address - Phone:704-366-9940
Mailing Address - Fax:704-844-8826
Practice Address - Street 1:6201 FAIRVIEW RD
Practice Address - Street 2:SUITE #200
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-3289
Practice Address - Country:US
Practice Address - Phone:704-366-9940
Practice Address - Fax:704-844-8826
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC830103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical